Monday, January 12, 2015

Book Synopsis: The End of Diabetes

Every bookstore and library is filled with aisles upon aisles of books on health, diet and self-help. I confess to having very mixed feeling about these books. My approach is to read some of these books to see if they contain anything useful, while being deeply skeptical of embracing any one book or author as the ultimate truth.

Most authors have a central thesis or pet theory. They are often guilty of cherry picking research studies with conclusions that support their pet theory. Don't get me started on how flawed and biased many of the research studies are in the first place. Most books are full of exaggerated claims and promises of a miracle. Authors go to great lengths to explain why everyone who believes anything different is flat out wrong.

But now and then I read these books anyway, because despite everything I just said, I've also come across valuable information, different viewpoints, messages of hope, ideas for changing habits and useful tips and recipes. There is a grain of truth in the hype. I will post a book review every now and then if I come across a book which says something interesting. This is one I read last month.The End of Diabetes: The Eat To Live Plan to Prevent and Reverse Diabetes by Joel Fuhrman, MD.

The crux of the book is this: Type II diabetes can be prevented and reversed with a nutrient dense diet of plant based foods. Here's what I took away from each of the chapters in this book. Quotes from the book are in italics.

Chapter 1: Understanding diabetes
The actual discussion of the causes of type I and type II diabetes in this chapter was quite garbled, in my opinion. But there is one bit of discussion at the end of the chapter that I really liked. Fuhrman criticizes the system of food exchanges used by the American Diabetic Association (ADA), which is the basis of how most nutritionists teach new diabetics to eat (for example, me when I was diagnosed with gestational diabetes). The ADA tries very hard to work with the standard American diet, recommending small portions of low-nutrient, low-fiber foods. "Cereal is OK, just eat only 1/2 cup of it"- that sort of thing. This leaves patients hungry and struggling to comply with the nutrition plan. Instead of just reducing portions of rice and tortillas when I had GD, I wish I had the sense to add in substantial portions of non-starchy vegetables which would have left me sated. Anyway, I agree with Fuhrman that the standard nutritional advice given to diabetics is very poor and it misses the boat.

Chapter 2: Don't medicate, eradicate"Clearly our present dependency on drugs to control diabetes without an emphasis on dietary and exercise interventions is promoting diabetic complications and premature death in millions of people all over the world". Fuhrman explains how medications-including oral pills and insulin- give type II diabetics a false sense of security that their diabetes is under control which leads patients to continue living the very same lifestyle that led to the disease in the first place. "The best medicine for diabetics is a high-nutrient, lower-calorie diet and exercise, not drugs. This is the only approach that lowers cholesterol, lowers triglycerides, and lowers blood pressure as it drops weight and blood glucose".

Chapter 3: Standard American diet versus a nutritarian diet
Fuhrman recommends what he calls a "nutritarian" diet- a diet rich in micronutrients (vitamins, minerals, phytochemicals). The foods it emphasizes are familiar ones- vegetables, especially green leafy vegetables, beans, nuts, seeds and fruits. Animal foods are strongly discouraged. So, he is essentially recommending a vegan diet but minus high-starch foods like white rice, refined grains and bread products. I found this chapter interesting because I eat a vegetarian, predominantly South Asian diet and the recommended foods like vegetables, beans, lentils, nuts and seeds are the very pillars of Indian home cooking.

Chapter 4: Reversing diabetes is all about understanding hunger"Toxic hunger appears at the lower plateau of the blood sugar curve, drives overeating behavior, and strongly increases the desire to consume more calories than the body requires, leading to weight gain and diabetes. True hunger, however, appears when the body has used up most of the calories from the previous meal...and is ready to be refueled. With a change of diet, toxic hunger gradually lessens and resolves, allowing individuals to be satisfied eating less".

"Wrong food choices lead to withdrawal symptoms that are mistaken for hunger...Initially, these symptoms are relieved after eating, but the cycle simply starts over again with the symptoms returning in a matter of hours. Eating when you experience toxic hunger in not the answer. Changing what you eat to stop toxic hunger is.""...trying to eat fewer calories is ineffective and almost futile. The secret is to desire fewer calories. The high consumption of low-calorie, high-nutrient foods such as raw vegetables, cooked greens, beans and seeds prepared in delicious combinations makes you feel physically full from all the fiber and satisfied from all the chewing. You lost the addictive cravings and then you simply and naturally desire less food."

Chapter 5: High protein, low carb counterattack
Here Fuhrman spends a great deal of time talking about the dangers of low-carb diets that are based on animal protein. I understand advocacy of vegetarian and vegan diets or meat-heavy diets for that matter but I get uneasy when authors cherry pick scientific studies to support their statements. So this is the part where I just moved on. People have all sorts of reasons for eating what they want to eat. I've made my choices so I just want to know how to maximize them.

This chapter also emphasizes that many plant based foods such as beans, lentils and vegetables have a high protein content.

Chapter 6: The phenomenal fiber in beans
Legumes such as beans, lentils, peas and chickpeas have protein, soluble and insoluble fiber and another type of fiber called resistant starch which has health benefits. "Considering their favorable effects on blood sugar and weight loss, they (legumes) are the preferred carbohydrate source for people who have diabetes or are at risk for diabetes".

Chapter 7: The truth about fat
Fuhrman emphasizes that whole plant-based high fat foods such as nuts, seeds and avocados are an important part of the diet. "I have encountered many individuals who have not thrived on vegan or flexitarian diets...Often they do not realize their real problem. They go back to eating large amounts of animal products, not knowing that they were fat deficient on their low-fat vegan diet. For most of these individuals, eating more healthy fats from nuts and seeds, taking a DHA supplement, and eating fewer starchy carbohydrates clears up the problem".

Chapter 8: The nutritarian diet in action
In this chapter, Fuhrman outlines his recommendations: The unlimited foods to be eaten liberally are all raw vegetables, all cooked green vegetables and other non starchy vegetables like tomatoes, peppers, eggplant, mushrooms, onions and cauliflower. Some fruit can be eaten. 2 cups a day of beans are allowed along with some nuts and seeds. "The salad is the main dish". Fuhrman recommends starting every main meal with a big salad.

My take on his advice from this chapter: Fuhrman's diet does not endorse oil, not even for sauteing vegetables. His recommended diet is restrictive and unappetizing with almost no salt. I understand that Fuhrman's patients are often very sick and I don't know what their particular needs might be. For myself, I know that spices and seasonings and sauces are all wonderful things that will support me in eating better.

There is a whole spectrum between eating to live (food strictly as fuel, which is right there in the title of this book) and living to eat (food as entertainment and indulgence). But there is plenty of space to thrive in a middle zone where many of the pleasurable and emotional connections of food are retained while eating food that nourishes the body and is right for one's own metabolism.

Chapter 9: The six steps to achieving our health goals
These involve making the commitment, drawing up a plan, tracking progress, making it public, making your kitchen healthy and the exercise prescription. "In place of dependency-inducing drugs, the proper medical intervention for this disease is to focus on the aggressive use of diet and exercise".

Chapter 10: For doctors and patients
This chapter is a pep talk for physicians to recommend diet and exercise changes and not just prescribe medication.

In summary, this book has two interesting take-home messages. The first is that people diagnosed with diabetes or at high risk for becoming diabetic have very good reason to be optimistic that at any time and any stage, they can change their lifestyle and reverse the disease to a remarkable extent, even reducing or eliminating the need for medication.

The second message is that a plant based diet is compatible with preventing and reversing diabetes. This is reassuring to anyone who has chosen to eat a vegetarian or vegan diet (or mostly vegetarian or vegan) for whatever reason and who feels a bit defeated by the prevailing climate of meat-based low-carb diets.

16 comments:

Thanks Nupur for summarizing the book for us. It was very helpful. I have been able to include lots of veggies into our diet but eating raw veggies is a challenge for me in winters when I can't stand the sight of a cold salad. So while I enjoy my greens in the form of soups and curries like the sarson ka saag I made yesterday I often wonder if I am highly compromising on the nutritive value. I wonder the same when I cook sprouts, am I missing on all the good stuff by cooking it? As long as it is warm and cooked I can eat anything in winters.

Priti- Raw vegetables have some nutrients that are reduced by cooking but also and equally importantly, cooked vegetables have some benefits that raw vegetables are missing- such as certain nutrients being more accessible and certain anti-nutrients being reduced. So eating some raw and some cooked vegetables seems ideal. Cooking makes many greens more palatable and breaks down some of the anti-nutrients in them, so I would not worry that saag compromises on the nutrition.

Also, not all cooking methods are the same. Boiling vegetables (and then throwing away the boiling liquid) drains away their water-soluble vitamins, but if the same vegetable were quickly sauteed or stir fried as in subzis, then most nutrients stay intact. High temp cooking like frying or charring is worse than others.

As for not wanting to eat salads in winter, I think salad conjures up this image of a big bowl of big leaves. Perhaps you won't mind eating raw veggie sticks with a warm bean dip, or wilted greens- greens tossed with roasted veggies or hot pasta- barely cooked but warm. Or a barely tender subzi of beets/cabbage- I love those and again, they are warm and hearty but in between raw and cooked. Grated koshimbirs are again raw veggies but not in the form of a big intimidating salad. If you can't stomach any raw veggies at all, well, Spring is only a few weeks away!

Thanks a lot, Nupur! I was unaware about anti-nutrients. I do enjoy warm salads and love koshimbir's paired with dals and curries, so nice of you to suggest me all the wonderful options. Henceforth, I will enjoy my saag guilt-free. Yay!!

Hi Nupur,I am a regular reader of your blog. Enjoy your recipes and your writing. When my husband was diagnosed with diabetes, we were shocked and upset. We try to maintain a healthy and prescription drug free lifestyle.Our search for an alternative led us to this wonderful publication called " Insulin: Our Silent Killer". This book discusses the author's battle with diabetes, and in my opinion provides a fairly well researched "thesis" on the disease. I am no expert, but his insights helped us in our attempt to control and regulate my husband's sugar levels. But, we had to read many books and go with the one that worked for us.

Hi Nupur, this is terrific! I am a type II diabetic and a vegan - I became vegan because of diabetes. 10 years on, my blood sugar is as near-normal as it can be without not being vegan - and the change to diet is all I have done. I'm not perfect. I eat too much and don't exercise enough. But I think it's one of the best things I could have done for my health.

ohh blogger just ate my super long comment so I am going to try again.

I missed posting a comment on your previous GD post so wanted to make sure to post on this one as I found myself nodding in agreement. Like you I was surprised and upset when I was diagnosed with GD with my first 2 years ago (even though I also have a family history of diabetes). I did binge a lot the week before my test so I blame that also..:). It was all such a pain- the pricking and monitoring but I ended up learning a lot. The advice that our nutritionist gave us seemed pretty good.And when I followed the 'diet' I never felt hungry surprisingly. She advised us (it was a group session) not to waste our 'starch/carb portion' on cereal,rice and pasta as we wouldn't be able to have much. It was fun learning that eating protein with fruits/carbs could slow down the absorption and thereby the glucose spike. So combos like carrots with cheese/yogurt, apples with almond/peanut butter and even the occasional ice-cream with a lot of nuts. I found that eating fried tofu didn't spike my sugar so used that as a filling indulgence (even though fried is not the best option lol). I also intuitively started substituting flour based carbs with starchy veggies when necessary. So if I wanted an extra bowl of veggies/chole i'd do that in lieu of bread. Like you, people commented on how strict I was being but I thought it was worth it for the sake of the baby- making sure to never be hungry of course.With my second (3 months ago) I was moderate with my diet but not too restrictive and much to the doctor's surprise and my relief didn't get GD. Phew! but because of that I was less careful towards the end of my pregnancy so your posts were timely.

I love your common sense approach to most things including food. Many people have a tendency to become ideological about many things including food. I like what you say about maximizing nutrition etc within your choices..

Hi Lavanya- You mention so many good points here! That GD can be a learning experience, how to combine carbs with fat and protein in the same meal to not spike blood glucose, eating more of legumes/veggies. Good luck to you and a very happy new year to you and your family!

Thanks Nupur, this is an interesting substantive review. Regarding comment from Priti above, I agree, regarding vegetables in winter! My naturopathic doctor has told me to cook most vegetables I eat, that for me at least, it is easier for my body to digest and use the nutrients when the vegs are cooked. - (I have IBS and gastritis, but there are many veggies that are more nutritious when cooked, such as carrots). - Jane

Even though I do not have diabetes and it does not run in my side of family (so, I hope I will not get it in future), this article is very helpful. I particularly like the point about understanding hunger. I think true well being is attained when one "desires" to eat healthy, desires to eat less and desires to exercise. When it comes to health, I do like Rujuta divekar's approach where she emphasizes on going back to the basics..home cooking, eating only how much is required, and tuning the mind so that we listen to our body's ques on how much food we need and what sort of food we need. Since the body generally benefits from eating nutritional food, it also signals us to feed it good and healthy food.Over the past years, I have been consciously practicing this "listening to the body" funda, and I have seen that I no longer struggle with portioning, over-eating or binging. Of course, my weakness of my love for chocolates is still there, but I have learnt to control that to a great extent too.

Neha- I agree with you that understanding hunger and curbing cravings is the crux of the matter- not summoning up willpower to fight against the urge to eat that bag of potato chips but not really wanting to particularly eat the potato chips in the first place. And true, the exercise "high" keeps one wanting to exercise as well.

I have kept my glucose level perfect for over 10 years. I was attending a medical practice which had a diabetes specialist nurse who called me to the surgery every 6 months. The nurse was removed. I had no call and began to make appointments with the doctor who did not specialize on diabetes. Now my glucose is over 90 and a specialist diabetes nurse is recommending insulin.My retina screening is perfrct, weight, bmi, heart /kidneys very good. I do an average of 60 miles walking per month plus 4 miles swim p.m and I do set dancing and aqua aerobics. I am extremely fit and very active. I am devastated with her recommendation. Any suggestions please?

Please keep in mind that I am not a medical professional and am not qualified to give you any advice. But in your place, I would get a second opinion (even a third or fourth if needed) until I found someone who understands diabetes and understands my medical history and lifestyle.

I don't understand the significance of your glucose being over 90. Is that fasting glucose? Fasting glucose under 100 is generally considered normal. A diabetes diagnosis is made by considering several tests (fasting glucose, glucose tolerance, A1C).

Type 2 diabetes can be managed by diet, exercise and non-insulin medication (depending on the individual) but Type 1 diabetes requires insulin therapy. I don't know what type you have been diagnosed with. Good luck! Your active lifestyle is inspiring!